Talk:Ménière's disease/Archive 1

Archive 1

Error

The main article states that beta histine can be taken during an attack. This is absolutely wrong and could misguide sufferers. Betahistine is taken on a regular dose in the hope that it reduces attacks. I don't edit wikipedia main pages so someone else please fix it ! —Preceding unsigned comment added by 94.169.97.109 (talk) 16:44, 3 September 2010 (UTC)

Technical

Technical issues concerning ease of direct linking trump correctly accented page titles (most internet users don’t know how to make accents with their keyboards and the existence of redirects is less than obvious). The full and correct accenting should be used within the text of the article though and the accented page titles should be redirect to the unaccented ones. See the thread at the bottom of Talk:Naming conventions about Andre Breton vs André Breton for complete explanation. In this particular case there is also an issue with extent of use: Meniere's Disease getting 16,300 hits on Google and Ménière’s disease only getting 490 (see talk:naming conventions on why this is important when redirects already exist for the more "popular" form). --maveric149

cough... both your André Breton examples above are indentical. I've taken the liberty of changing one to a plain "e" Tarquin

Don't know what you mean -- André Breton is a redirect to Andre Breton. --maveric149

Oh, I see what you did, thanks. --maveric149

Eponym

The eponym was reviewed in the Lancet[1] JFW | T@lk 23:49, 25 December 2005 (UTC)

Requested move

Ménière’s disease → Ménière's disease … Rationale: Remove directed single quotation mark and make it an undirected single quotation mark. --waffle iron ^talk 05:42, 11 August 2006 (UTC)

The following is a closed discussion of the proposal. Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section.

The result of the proposal was moved per unanimous consent. — Arthur Rubin | (talk) 00:26, 18 August 2006 (UTC)

Survey

Add "* Support" or "* Oppose" followed by an optional one-sentence explanation, then sign your opinion with ~~~~

• Support. I'm sure there's something about this in WP:NC somewhere. The closest I can find is WP:DASH, which states that en-dashes in article titles should be replaced with hyphens to make them typable; the situation with untypable "smart" apostrophes is identical. — Haeleth Talk 09:41, 11 August 2006 (UTC)
• Support. David Kernow 05:59, 13 August 2006 (UTC)
• Support. This was briefly discussed in Wikipedia talk:Naming conventions. -- Sakurambo 桜ん坊 09:39, 13 August 2006 (UTC)

Discussion

Add any additional comments

The above discussion is preserved as an archive of the proposal. Please do not modify it. Subsequent comments should be made in a new section on this talk page. No further edits should be made to this section.

Citation needed tag

Which definition or dx criteria state that "A diagnosis may be made in the absence of all four classic symptoms"? For example Committee on Hearing and Equilibrium, Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere's disease, Otolaryngology-Head and Neck Surgery, 113:181-185 requires: "Either tinnitus or aural fullness (or both) must be present on the affected side to make the diagnosis for reporting purposes under these guidelines." <admittedly this is for reporting purposes> FWIW - AvB ÷ talk 09:43, 5 October 2006 (UTC)

I corrected the part about Darwin being a Meniere's patient. He might have had an inner ear disease, but in the absence of hearing loss and aural fullness there is no basis for a diagnosis.

Layraud 09:24, 1 December 2006 (UTC)Layraud

Conjectural Diagnosis

The article on Vincent van Gogh has been expanded and a link to a separate article on Vincent van Gogh's medical condition is now included. I have therefore amended/linked Famous Sufferers in line with these changes. I have also edited/qualified the Milligan & Clare "See Also" to neutralise and accord with the foregoing. I think the Starry Night reference now looks frivolous. Any thoughts?

Ynysgrif 16:16, 27 December 2006 (UTC)

Under: 'See Also'

As it is written down now, it would suggest that this long list of people would have Meniere's disease as a consequence of syphilis. This is obviously nonsense, or to say it more politely, where is the evidence that Syphilis causes Meniere's disease? Layraud 11:52, 20 March 2007 (UTC)

Either I am ging to delete "probably caused by syphillis" or the whole phrase about these people. Problem is that I don't know what that book really says. Anyone? Layraud 09:39, 30 March 2007 (UTC)

Proposed external link

Please can someone explain the background to this unusual notice (I'm aware of the WP policy). Who has made the decision and why ? -

===========================()===============================
| DO NOT ADD MORE LINKS TO THIS ARTICLE. WIKIPEDIA IS NOT A COLLECTION OF |
| LINKS. If you think that your link might be useful, do not add it here, |
| but put it on this article's discussion page first or submit your link |
| to the appropriate category at the Open Directory Project (www.dmoz.org)|
| and link back to that category using the disease/Archive 1 Ménière's disease/Archive 1 at Curlie template. |
| |
| Links that have not been verified WILL BE DELETED. |
| See Wikipedia:External links and Wikipedia:Spam for details |
===========================()===============================

Knowing nothing about the subject, but investigating for my elderly neighbour who's considering endolymphatic sac surgery I thought that the following was a good overview with a load of references for further investigation, from a good source. Is it worth adding ? -

Saeed, Shakeel R (31 January 1998). "Fortnightly review: Diagnosis and treatment of Ménière's disease". BMJ. 316 (7128). London: BMJ Publishing Group: 368–372. {{cite journal}}: Check date values in: |date= (help)

It also contradicts the John Hopkins cited age range and male-female ratio in the article -

"Ménière’s disease predominantly affects white people, with a prevalence in the United Kingdom of 1 per 1000 of the population, both sexes being represented equally. The disorder may occur in children but has a peak onset between 20 and 50 years of age. The incidence of disease affecting both ears increases to over 40% with longer follow up."

Thanks -- John (Daytona2 · talk) 19:13, 11 December 2007 (UTC)

Here is a very interesting personal account on Ménière’s disease:

"People who don’t know me assume I’m slightly odd when I press my face to speakers and musical instruments. Commuters appear frightened by my soulful relationship with my iPod; perhaps they’re wondering if weeping my way through a bit of Beethoven on the bus is evidence that I shouldn’t be allowed out on my own. "

From the American Hearing Research Foundation [2]

Why no reference to AAO HNS CHE 1995 ?

I know little of the subject but isn't this a pretty standard starting point ? I can't seem to locate it on the web so a link would be good. Thanks -- John (Daytona2 · talk) 19:36, 11 December 2007 (UTC)

Potassium intake

This edit removes a statement regarding potassium and Meniere's symptoms.

Several days of googling leads to believe this statement is an improper synthesis. I've yet to find a reliable journal state that potassium intake has any sort of large effect. Note that a "reliable journal" is not an anecdote. Ijustam (talk) 20:10, 26 June 2008 (UTC)

Lancet review

doi:10.1016/S0140-6736(08)61161-7 JFW | T@lk 20:30, 27 August 2008 (UTC)

Assessment

To reach B-class status, it needs more high-quality references, particularly in #Progression, which is entirely unreferenced.

I've tagged a handful of things. Additionally -- and this is not required for B-class status -- you might try weeding the "Notable patients" list, which is rather on the long side, and the references need reorganized. ==Footnotes== should really only have short citations, instead of all short citations plus all full citations that are only used once. All full citations properly belong in the main ==References== list. One way to do this is to define WP:REFGROUPs. Personally, my usual approach is to merge all short and full citations into a single section, adding the full citation to the first short citation. However, there are many acceptable approaches, and whichever you like best is fine. WhatamIdoing (talk) 19:11, 20 September 2008 (UTC)

There is a lot of confusion over exactly what Meniere's "Disease" is. Sufferers stress over getting a diagnosis, yet it is not a disease as such, rather an idiopathic condition. Here is as good an explanation you will get from Dr Steven D Rauch of Massachusett's Eye and Ear Infirmary. Boston: [[3]] —Preceding unsigned comment added by 119.172.170.169 (talk) 04:28, 1 April 2009 (UTC)

Support

As MD and migraine-associated vertigo can co-exist, I would like permission to add a small paragraph stating so, with a citation, along with an external link to a forum dedicated to supporting sufferers of both illnesses. (UTC)julcal —Preceding unsigned comment added by Julcal (talk • contribs) 03:06, 12 April 2009 (UTC)

howto

"To ensure your manganese is absorbed, ensure it is taken in Amico Acid Chelate form." WP:NOT a how-to 22:42, 13 June 2010 (UTC) —Preceding unsigned comment added by 67.49.0.138 (talk) 08:27, 8 June 2009 (UTC)

does this include ppl who are born deaf in one year and slightly deaf in the other?

cause i was born deaf in my right ear and slightly deaf in my left ear and still wearing a hearing aid but the fact that some of the symptoms of this happens to me every down and then...i dont know why. or understand it. —Preceding unsigned comment added by 97.100.214.142 (talk) 23:54, 19 April 2010 (UTC)

can this be caused by pressure on both sides of your ears with hands —Preceding unsigned comment added by 207.183.191.80 (talk) 03:59, 6 October 2010 (UTC)

Additional Pop Culture Reference

Wasn't one of the characters in Beethoven Virus, a Korean drama, affected by Ménière's disease? 97.81.65.138 (talk) 19:55, 25 November 2010 (UTC)

Some weird discrepancies

I have a husband with Meniere's, a severe form that has left him disabled, and I must admit there were a few things in the article that do not fit anything the doctor has said, or the research we have done, which left me confused as to the accuracy of some of the sources, including a book by Haybach. One good resource is http://www.menieresinfo.com/start.html, but I am sure there are others.

This sentence is inaccurate: "Attacks of vertigo can be severe, incapacitating, and unpredictable and can last anywhere from minutes to hours[7], but no longer than 24 hours." I am not an editor here and usually don't have time, but I was trying to find some other good sites to send friends who wish to know more about my husband's condition and was very disappointed in the article presented. My husband has had attacks that have lasted over a week, sometimes up to two weeks where I had to bring him food, he couldn't move or he would fall over, and his world is always moving ever so slightly even when he is not having an outright attack.

"Ménière's typically begins between the ages of 30 and 60," this may be true, but my husband's started in his late 20's.

"Ménière's disease, being unpredictable, has a variable prognosis. Attacks could come more frequently and more severely, less frequently and less severely, and anywhere in between.[44] However, Ménière's is known to "burn out" to a stage where vertigo attacks cease over time.[45]"

The last sentence in this is entirely false! Most doctor's we've spoken too do not believe that meniere's will "burn out." There is no evidence to suggest that it does this, and this also puts false hope in some people. The "burn out" suggested here suggests it almost gives up, but the burn out that is believed to happen is when the disease progresses to such a point that you lose complete hearing, and it may lesson the vertigo attacks because your body readjusts, but this rarely happens, and we've talked to some top doctor's in the Meniere's study and they think the "burn out" suggestion is not accurate.

Also, the surgery section should be more clear as well. My husband's doctor, one of the leading Meniere's doctors, does not recommend most surgeries unless nothing else in the world helps, because one of the risks is that your body will reject the surgery and you will have constant severe meniere's symptoms with no relief. You'd have to find information on that for confirmation, but if you can find relief any other way then he won't suggest surgery because the risk is too great.

24.121.155.59 (talk) 17:07, 12 December 2010 (UTC) I hope someone takes a look at this and makes some adjustments. The article is not all awful, but I felt is was very inaccurate in some places, and even misleading in others.

I've actually run into a lot of these same arguments while doing my own research. Meniere's is a really fickle beast that doesn't like to be classified into statistics. You ask anyone with Meniere's and you'll see that everyone's situation is different. I've talked to my otologist and gotten answers different than literature. Really it boils down to who you want to listen to. Haybach's book is a good source of information but is extremely outdated, published over 20 years ago. I referenced what I thought was relevant and not terrible advice (the book promotes ear candling, which is a terrible idea). You're right about the burnout phase. That probably needs to be reworded. "Burn out" refers to a point where the ear is so damaged that it no longer functions correctly and the brain ignores it. The surgery section is there because those operations exist, not because they're good ideas for everyone. Like I said, it's difficult to write about Meniere's because there's so little known about it. — Preceding unsigned comment added by Ijustam (talk • contribs) 06:19, 13 December 2010 (UTC)

Needs updating with reviews from last 5 years

• Greenberg SL, Nedzelski JM (2010). "Medical and noninvasive therapy for Meniere's disease". Otolaryngol. Clin. North Am. 43 (5): 1081–90. doi:10.1016/j.otc.2010.05.005. PMID 20713246. {{cite journal}}: Unknown parameter |month= ignored (help)
• Alexander TH, Harris JP (2010). "Current epidemiology of Meniere's syndrome". Otolaryngol. Clin. North Am. 43 (5): 965–70. doi:10.1016/j.otc.2010.05.001. PMID 20713236. {{cite journal}}: Unknown parameter |month= ignored (help)
• Martín González C, González FM, Trinidad A; et al. (2010). "Medical management of Ménière's disease: a 10-year case series and review of literature". Eur Arch Otorhinolaryngol. 267 (9): 1371–6. doi:10.1007/s00405-010-1265-4. PMID 20454798. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Pullens B, Giard JL, Verschuur HP, van Benthem PP (2010). "Surgery for Ménière's disease". Cochrane Database Syst Rev (1): CD005395. doi:10.1002/14651858.CD005395.pub2. PMID 20091573.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Doc James (talk · contribs · email) 06:20, 19 December 2010 (UTC)

Reviewed in the BMJ also: doi:10.1136/bmj.g6544 JFW | T@lk 23:44, 15 November 2014 (UTC)

dumb newbie questions

1. What is with the list of notable cases? It just makes no sense to me. I mean Lou Gehrig's disease, sure. But this thing? Will we have notable cases for lung cancer, heart disease, or rashes on the butt?

2. Why do we put the list of external links in the infobox instead of down in the normal penalty box at the very end? (P.s. They are also pretty cryptic with the letters and numbers, not having...um...words.)

TCO (reviews needed) 19:49, 17 July 2011 (UTC)

1. The historical ones are I think are interesting (especially the case for Van Gogh) but the current/popular society ones are untrue and people keep adding to them. One of these days I'm just going to delete it.

2. I have no idea what you're talking about.

ɯɐʇsnɾı (talk) 20:30, 3 August 2011 (UTC)

These are not "dumb newbie questions" at all, TCO - they very germane, serious questions. (Although "rashes of the butt" is a good one - Ha!)

1. Instead of a pile-on, me-too list of persons with MD (info that is more relevant to the articles of the people singled out, in my opinion), fold the discussion of several of the more informative examples into the text to add more depth and to illuminate the text or add them as an extended footnote. Lists seem to me to be an amateurish way to pad an article, but (sigh!) WP is stuffed full of them.

My objection goes double for Van Gogh, as a speculative case of MD at best. [ADDITION: Likewise, Charles Darwin. Perhaps these names will evolve into a list of people "Conjectured to have MD". Wordreader (talk) 20:04, 22 November 2014 (UTC) .^_^.]

2. I think info box links are funky, too, a way to squeeze in more links. I looked at a handful of articles on medical conditions (Rheumatic fever, Chicken pox, Hepatitis, Irritable bowel syndrome, Stroke, Bone fracture, and Ménière's disease: all have such a list of links in their info boxes whereas Depression (mood) has no info box at all.)

According to Wikipedia:Manual of Style/Infoboxes: "Purpose of an infobox: When considering any aspect of infobox design, keep in mind the purpose of an infobox: to summarize key facts that appear in the article. The less information it contains, the more effectively it serves that purpose, allowing readers to identify key facts at a glance."

Installing links into an info box seems to be the antithesis of that directive. Not only do links fail to provide key facts, but when you click on one, you are taken to long articles on the subject to wade through. I cannot reconcile that.

Thank you, Wordreader (talk) 18:10, 22 November 2014 (UTC)

Does Viagra causes an attack or cures it?

I was wondering, since Viagra and other erectile dysfunction drugs are vasodilators, they should help the circulatory system put the endolymph back where it belongs. but I have seen in the viagra page that it may cause sudden hearing loss, so maybe it causes a meniere attack. Anybody has info on this?. — Preceding unsigned comment added by Granito diaz (talk • contribs) 12:03, 20 September 2012 (UTC)

Menière

The spelling of Menière is incorrect. There should not be an acute accent on the first e. Compare French Wikipedia. The name is not "May knee air" but "Mun knee air". Everybody got to be somewhere! (talk) 22:26, 30 June 2015 (UTC)

revision

I found more recent sources and updated this whole thing in this series of diffs. Most of the refs were to two books from the late 1990s. Oy. Jytdog (talk) 10:46, 13 June 2016 (UTC)

Naganawa S, Nakashima T (2014)

This source does not support this sentence

"while most maintain that even if EH is necessary, it is not alone sufficient to cause MD and other factors are involved"

but this one

"to the point where some again say that EH definitely causes MD",

The authors did not deal with the issue "not alone sufficient", but wrote in their Conclusions:

"From the results reported in the literature, all patients with Meeniere’s disease have endolymphatic hydrops in EHI [endolymphatic hydrops imaging]"

The ref will thus be moved accordingly.

--Saidmann (talk) 12:09, 23 June 2016 (UTC)

Naganawa says very clearly: "From the results reported in the literature, all patients with Ménière's disease have endolymphatic hydrops in EHI; however, not all subjects that show endolymphatic hydrops by EHI present with the typical symptoms of Ménière’s disease. The mechanism of vertigo attack should be clarified in the future" It is supported. Jytdog (talk) 12:36, 23 June 2016 (UTC)

The two sentences added to the quote make no difference at all. They do not imply that the authors regarded EH as "not sufficient to cause" MD. Instead they are fully consistent with the prevailing view since 1938 that EH precedes MD und leads to the known MD symptoms once it has developed a sufficient strength to cause damage to the inner ear sensory cells. As yet, there is no evidence in the literature - neither direct nor indirect - that EH is not sufficient to cause MD. As to the history, please note the work of Kyoshiro Yamakawa, Charles Skinner Hallpike and Hugh Cairns (surgeon) (sources: here and here). --Saidmann (talk) 11:17, 24 June 2016 (UTC)

• • • PMID 26932948 (Crowson 2016) Prevailing theories on its pathogenesis point to endolymphatic hydrops as one derangement responsible for producing dysfunction within the cochlea and peripheral vestibular apparatus. While the exact pathophysiology remains unknown, it is held by many that hydrops of the endolymph within the labyrinth is contributory. ... As firm evidence of a unifying pathogenic mechanism is lacking, MD has proven difficult to successfully manage.
    • PMID 25750534 (Foster 2015) A second factor that has impaired treatment progress is the lack of consensus on a mechanism for the disorder. There have been two major opposing factions since the Hallpike and Cairns paper was published. One broad group believes that endolymphatic hydrops and Ménière’s disease are synonymous and that treatments directed at hydrops should be sufficient to control symptoms. Within this “hydrops group”, it is currently believed that the onset of hydrops is probably multifactorial, including viral infection, autoimmunity, and other disorders as causes. ...There is no longer a clear consensus on the mechanism by which hydrops results in attacks in this group, but treatments continue to focus on decompressing the hydropic ear either through medications or by surgical intervention. The other major group, the “migraine group” believed early on that migraine explains many cases of the disorder, perhaps through the mechanism of ischemia due to vasospasm. Some researchers have rejected hydrops as causal in the disorder. Genetic factors or the presence of an ion channelopathy have been invoked to explain the association.
    • PMID 26668402 (Lim 2015) Although there are still uncertainties surrounding the aetiology of Meniere’s disease, it is generally agreed that the underlying pathology is that of EL hydrops, which may be caused by overproduction of endolymph at the stria vascularis or compromised absorption of endolymp. ...The cause of vertigo in EL hydrops is controversial.
    • PMID 26231275 (Seemungal 2015) Human temporal bone studies have linked MD symptoms to the accumulation of endolymph within the cochlear duct (scala media) and the sacculus in the inner ear. It is thought that this endolymphatic hydrops begins with derangement of the ionic composition of the scala media. However, current data support the hypothesis that endolymphatic hydrops is an epiphenomenon associated with a variety of inner ear disorders, and familial clustering indicates that genetics and environmental factors contribute to its development
    • PMID 25766597 (Ishiyama 2015) (not currently cited) It was not until almost 80 years later that the most prominent and consistent pathological correlate of MD was revealed in postmortem humantemporal bone studies: endolymphatic hydrops (EH), the dilation of the membranous labyrinth of the inner ear....It had been proposed that EH leads to the symptoms of MD—vertigo spells and hearing loss—because of potassium intoxication of the hair cells during membrane ruptures, allowing the potassium-rich endolymph to paralyze the sensory hair cells that are located within the perilymph. Temporal bone studies demonstrated that nearly all cases of MD are associated with EH; however, not all EH cases are associated with the symptoms of MD....In that study, it was proposed that EH is an epiphenomenon of MD, rather than the etiology of symptoms. The currently accepted American Academy of Otolaryngology–Head and Neck Surgery (AAO– HNS; 1995) criteria for definite MD include two or more spontaneous episodes of vertigo lasting 20 min or longer, audiometrically documented hearing loss on at least one occasion, tinnitus or aural fullness in the treated ear, and other causes excluded. Probable MD is similar, except there is only one episode of vertigo, whereas possible MD includes episodic vertigo of MD type without hearing loss or hearing loss without definitive vertigo episodes (such as disequilibrium spells).
    • PMID 25882471 (Lopez-Escamez 2015 - the current diagnositic consensus and our strongest source) Menière’s disease (MD) is a multifactorial disorder where the combined effect of genetics and environmental factors probably determine the onset of the disease. It is associated with the accumulation of endolymph in the cochlear duct and the vestibular organs in histopathological studies, although endolymphatic hydrops (EH) per se does not explain all clinical features, including the progression of hearing loss or the frequency of attacks of vertigo.

Those are all the reviews I found from 2016 and 2015. Some say that EH causes MD but that it not the current consensus in the field. I do understand that you are in the camp that believes EH causes MD. WP cannot reflect your POV; it needs to have a neutral point of view and reflect whatever the mainstream view is. For MD, it is "we are not sure, but it may be ED". Jytdog (talk) 18:14, 24 June 2016 (UTC)

There are no such "camps" in this field. The only paper that suggested there are camps is PMID 25750534 (Foster 2015). Well, this paper is not a review (PubMed bots occasionally get it wrong) but a highly speculative theoretical paper by an outsider making PR for his clinical institution. None of your other quotes is in conflict with what I wrote. What is still unclear are the causes of EH. But that EH is preceding MD and causal to its symptoms has always been the prevailing view - as close to a consensus as possible in science - since 1938. The recent MRI data have only confirmed the available knowledge. (Actually, if you look at the mechanisms by which EH leads to transient and/or permanent functional knockouts of sensory cells in the inner ear, you will see why concepts without EH contribution never had a chance in the history of MD research.) --Saidmann (talk) 11:20, 25 June 2016 (UTC)

Every one of those sources says the cause is not certain and contradicts what you wrote. Seemungal even says EH is just an "epiphenomenon" which is about as far from causal as you can get; you are not even engaging with the quotes I took time out of my day to copy here for you. You cannot rely on that one source to outweigh all the others and definitely not the consensus diagnostic source. Not at this time. Maybe in a year or two. I don't know how things are done in German Wikipedia but in English Wikipedia NPOV means we do not cherry pick sources and we are not bleeding edge. We are conservative. The overwhelming WEIGHT of recent sources is that the cause is uncertain. I am going to ping WP:MED because you are just not listening; we'll have to get more voices here. Jytdog (talk) 11:42, 25 June 2016 (UTC)

"Seemungal even says EH is just an "epiphenomenon"" -- No, your quote was "current data support the hypothesis that endolymphatic hydrops is an epiphenomenon". This means Seemungal thinks that there are data that support ... . I know what I read. Seemungal has no evidence - just an opinion. Opinions on hypotheses never constitute a contradiction against empirical facts. They present - at best - a theoretical alternative. A possible alternative is something very different from a contradiction. (Mind you, I do not "rely on that one source" but on all literature about MD that has appeared since 1938). --Saidmann (talk) 14:53, 25 June 2016 (UTC)

We now have another voice. see the section above. Your stance is not sustainable and is not how we operate at WP:MED in en-wiki. I am now concerned about your editing in general, fwiw This article was in a terrible state when I came across it with very old sourcing and pure WP:OR/SYN, like this whole section, which you added. Jytdog (talk) 03:02, 26 June 2016 (UTC)

Please do not insinuate that the poor state of this article has something to do with my edits preceding yours, i.e., the ones from 13 April 2016‎ until 28 April 2016‎. A look into the revision history will reveal that these edits had improved the article considerably. --Saidmann (talk) 15:12, 26 June 2016 (UTC)

Cause

User:Saidmann about this dif. Seemungal 2015 (PMID 26231275) and Crowson 2016 (PMID 26932948) and the 2015 diagnostic consensus (PMID 25882471) and even Naganawa 2014 (PMID 24500139) are clear that HE appears necessary but not sufficient to cause MD; the diagnostic consensus document (probably our strongest source right now?) is clear that EH "per se does not explain all clinical features, including the progression of hearing loss or the frequency of attacks of vertigo". The mainstream view appears to be that the cause and mechanism of MD are uncertain.

I do ackowledge that Gurkov (PMID 27083887) comes down strongly on the side of yes for EH being the cause but that does not appear to be the mainstream view at this time. Jytdog (talk) 16:10, 22 June 2016 (UTC)

First, the two reviews that I referenced do not report a "view" but unequivocal quantitative data. They are based on all empirical research and all MRI data on this issue (data from hundreds of patients). The papers that you mentioned, however, did present "views", apparently from a time before the MRI data. So there can be no doubt what the current - reviewed - state of the art is. It often happens in science that results achieved by a novel technology - in particular imaging results - outdate a view that is present in many preceding publications.

Second, The question concerning "necessary but not sufficient" is a different one. The new MRI data established that EH is necessary for MD. The question if it is also sufficient cannot by dealt with by this technique, and nobody has said so. I will add a clarification to exclude the possibility of such a misunderstanding.

--Saidmann (talk) 19:08, 22 June 2016 (UTC)

You are pushing the certainty of EH way too hard - and hear this - beyond what the bulk of current MEDRS sources say'. That is not acceptable in Wikipedia. Please stop editing warring over that and actually discuss it - that was the point of my objection and you restored it without barely moving. I am have attempted to push this back toward what the majority of current MEDRS sources say. If you do not agree then we will have to move to dispute resolution. Jytdog (talk) 19:43, 22 June 2016 (UTC)

I do not push anything. Neither do I edit war. I added to the original edit in order to meet your concerns. The current (extended) edits are written fully according to MEDRS. MEDRS does not demand anywhere that state-of-the-art reviews have to be counted to see if their number is bigger than that of before-state-of-the-art reviews. What you call "the bulk of current MEDRS sources" are no longer current sources in this particular respect. They do not refute the MRI data, they do not even mention them. This implies that their authors apparently were not yet aware of them. Things like that happen all the time in science. Reporting the state of the art - as seen in current topical secondary sources - is what MEDRS demands, and that is what I did. --Saidmann (talk) 20:13, 22 June 2016 (UTC)

What you are pushing is that EH is absolutely the cause. Please keep in mind that an MRI finding is not part of the consensus diagnostic definition as of 2015. It may be that the next consensus diagnostic (they seem to revisit every two years or so) may raise a finding of EH via MRI with contrast to be a definitive diagnostic criteria but the field is not there yet. What NPOV requires - which is policy - is that content reflect the mainstream view reflected in sources -- MEDRS defines the sources we look at. And we don't just pick one, we look at all the recent sources and see what they say. We do not follow the bleeding edge. This is why I said that the 2015 diagnostic consensus is our strongest source - it is recent and represents the current consensus thinking in the field. Jytdog (talk) 20:16, 22 June 2016 (UTC)

There is a difference between

A. establishment of EH as necessary precondition of MD through MRI in basic clinical research

and

B. establishment of EH detection via MRI as a diagnostic tool for MD in common clinical practice

A is the case. B is not (yet) the case, and nobody has said so. Therefore the "consensus diagnostic definition as of 2015" is not relevant here. Please let's work without Straw men.

You might also note that the "consensus diagnostic definition as of 2015" indeed did mention the new MRI technique in section 4.2 (page 5, as part of "comments"), but referenced a source of 2013, apparently because the more relevant sources that I referenced were not yet available during the preparation of the consensus paper. So even this paper, which deals with diagnostics not basic science, highlighted the importance of the new development and thus supported my edits.

--Saidmann (talk) 11:50, 23 June 2016 (UTC)

(made aware of this discussion at WTMED) I have a sense of this from my own knowledge, but to be more rigorous I looked at a few MEDRS and found that the etiology of MD remains controversial. It's clear that EH is present consistently, but it's also clear that many people with EH don't have symptoms and therefore they don't have MD. Examples include:

• the UpToDate article on MD, which says, "The mechanism responsible for symptoms of Meniere disease is also unknown. While endolymphatic hydrops is present in all patients with Meniere disease, not all patients with endolymphatic hydrops have symptoms."
• Ferri's CLinical Advisor, which says that the etiology of MD is "Unknown; viral, autoimmune, and genetic causes have been suggested.; Endolymphatic hydrops is the postmortem histologic hallmark. Recent research suggests that endolymphatic hydrops may create cytochemical changes that disturb endolymphatic fluid homeostasis, leading to spiral ganglion cell death."
• Cumming's Otolaryngology, the chapter on Peripheral Vestibular Disorders (2015) by Crane and Minor, which says (intro on MD) "Despite this well-known symptom complex, Meniere disease remains controversial; often it is difficult to diagnose, to determine the pathogenesis, and to define optimal treatment." and (Pathogenesis) "Because of significant individual anatomic variation, current imaging techniques are neither diagnostic nor predictive for Meniere disease. Imaging has a well-established role in the diagnosis of Meniere disease and helps to exclude other possible causes of dizziness and unilateral hearing loss, such as vestibular schwannoma."

I've looked at other sources as well, and it's clear that a diagnosis of EH is insufficient for the diagnosis of MD - the latter has additional requirements. — soupvector (talk) 02:39, 26 June 2016 (UTC)

agree w/ soupvector (on ref #2 and #3 used above in Ménière's disease)--Ozzie10aaaa (talk) 12:51, 26 June 2016 (UTC)

There seems to be a misunderstanding concerning the term "sufficient". The fact that not all EH is associated with MD does not imply at all that EH is not sufficient. It is like in nearly all other pathologies: a deviation must be strong enough - go beyond a certain threshold - in order to trigger the symptoms. We do not say a cause is insufficient if it can be observed already in sub-threshold cases. We say it is sufficient if no other factors are necessary. This is the case with MD. As yet nobody has demonstrated that an additional factor - on top of EH - is necessary to cause MD. What is uncertain is which and how many factors cause EH. Can we agree on this?

Diagnosis is a different matter. A diagnosis of EH - once established in clinical routines - will not be sufficient for a MD diagnosis. But all MD symptoms can be attributed to EH. This has been the prevailing view since 1938. --Saidmann (talk) 13:25, 26 June 2016 (UTC)

I understand what "sufficient" means in the context of pathophysiology. My understanding of the relationship between EH and MD is that the former does not fully explain the latter, including patterns of vertiginous symptoms and the progression of hearing loss. That we don't know the other factor(s) contributing to MD does not mean they don't exist; reliable sources still raise the possibility that EH is not causal but mechanistically linked (i.e. an epiphenomenon). Your repeated reference to "since 1938" carries zero weight, as medical knowledge can evolve rapidly. — soupvector (talk) 17:29, 26 June 2016 (UTC)

The fact that EH does not fully explain MD is due to the fact that we do not know how EH comes about. However, there is no need to assume unknown further factors. Vertiginous symptoms and progression of hearing loss are fully explained by membrane ruptures due to EH, which lead to dysfunctions and damages of sensory cells. Of course, EH must be an epiphenomenon of something. It must be caused by something, and we do not know what. This, however, does not touch the issue that EH is sufficient to explain all symptoms of MD. When I stressed 1938, it was to show that between then and now alternative concepts have never been more than speculations without evidence. --Saidmann (talk) 18:18, 26 June 2016 (UTC)

Your claims/beliefs are not supported by the MEDRS that have been cited and quoted here on this talk page and in the article. Unless you can provide evidence that scientific consensus supports your claims, they don't belong on WP. — soupvector (talk) 21:04, 26 June 2016 (UTC)

For many issues in science and medicine there has never been a consensus. That does not mean we have to cut them out or pick views at random. We present the prevailing views. The currently prevailing view on the issue of EH and MD is - for example - well represented by PMID 27083887. And this view is not in conflict with any other relevant secondary source. What you and Jytdog have done is misreading and misquoting sources, and it appears to me that you are not even aware of the generally accepted mechanisms by which EH causes hair cell dysfunctions and damages and thus the symptoms of MD. Otherwise you would not have grossly misread and misquoted the literature. --Saidmann (talk) 11:24, 27 June 2016 (UTC)

please refrain from non-productive comments you are not even aware of the generally accepted mechanisms[4]...in terms of [5] isn't too shabby, though a better reference is welcomed,thank you ([6])--Ozzie10aaaa (talk) 14:15, 27 June 2016 (UTC)

Thank you for pointing to the NIH site "Ménière's Disease". It confirms what I have written here by stating:

"What causes the symptoms of Ménière’s disease?"

"In Ménière’s disease, the endolymph buildup in the labyrinth interferes with the normal balance and hearing signals between the inner ear and the brain. This abnormality causes vertigo and other symptoms of Ménière’s disease." ["endolymph buildup in the labyrinth" is a lay expression for EH.]

Did you mean that this NIH text should be added to the other ref, or was the NIH text just meant as an encouragement to add another secondary source from the literature? --Saidmann (talk) 16:01, 27 June 2016 (UTC)

Saidman read the very next paragraph, which is the next question and answer at that site - please quote it here, like you did the one. Do it. Jytdog (talk) 16:12, 27 June 2016 (UTC)

Also the very next paragraph fully confirms what I have written repeatedly. It deals with the question of the cause(s) of the cause, i.e. "Why do people get EH?" or "What is the cause of EH?" Perhaps the NIH words will now cause more of an effect than mine. --Saidmann (talk) 16:28, 27 June 2016 (UTC)

You just lost all credibility with that blatant denial of what words on a page say, and I will not be responding to you further on this page. The next paragraph says: "Many theories exist about what happens to cause Ménière’s disease, but no definite answers are available. Some researchers think that Ménière’s disease is the result of constrictions in blood vessels similar to those that cause migraine headaches. Others think Ménière’s disease could be a consequence of viral infections, allergies, or autoimmune reactions. Because Ménière’s disease appears to run in families, it could also be the result of genetic variations that cause abnormalities in the volume or regulation of endolymph fluid." I will be WP:SHUNing you going forward. Jytdog (talk) 16:34, 27 June 2016 (UTC)

Well, then a concluding summary for other readers. The chain of causation can be formalized as follows:

Unknown ⇒ EH ⇒ MD

Now, claiming that there are some that consider EH ⇒ MD as correct, but others that consider Unknown ⇒ MD as correct, clearly is besides the point. It is wrong. There is no such divide in this field. The article needs to be corrected accordingly. --Saidmann (talk) 22:19, 27 June 2016 (UTC)

The prevailing opinion (consensus) seems to be, clearly IMHO, that EH is a necessary but not sufficient condition for MD to manifest. Of note, even the Gürkov article highlighted above acknowledges that a substantial proportion of people with vestibular MD lack evidence of EH (In contrast to the “cochlear MD”, the patients with “vestibular MD” show more variability, but still a significant portion of them has EH., followed by some speculation). We should not be dogmatic where the MEDRS demonstrate uncertainty. — soupvector (talk) 00:46, 28 June 2016 (UTC)

Thank you. With this observation, that what you called "uncertainty" collapses to a few cases of vestibular MD, a subgroup of MD. However, the possible explanation offered by Gürkov et al. is not based on "some speculation" but on the established fact that "in this “vestibular MD” group" there has not yet been identified a distinctive vestibular phenotype." It can be confused with other pathologies. So the uncertainty lies in the diagnosis of vestibular MD. This means we have no evidence that there ever has been a patient with definite vestibular MD but no EH. Therefore, it is not appropriate to infer uncertainty on the presence of EH in MD generally just because of the phenotype uncertainty of vestibular MD. Because of this, the summary of Gürkov et al in their abstract is fully in line with good practice in science publishing: "In this review, we summarize the existing knowledge from temporal bone histologic studies and from the emerging evidence on imaging-based evaluation of patients with suspected Menière’s disease. These indicate that endolymphatic hydrops is responsible not only for the full-blown clinical triad of simultaneous attacks of auditory and vestibular dysfunction, but also for other clinical presentations such as “vestibular” and “cochlear Menière’s disease”."

According to my experience a close analysis of literature is not dogmatic but appropriate and often necessary. Good WP articles should be based on close reading of this kind. --Saidmann (talk) 11:35, 28 June 2016 (UTC)

Another recent first-class secondary source that fully agrees with the Gürkov review: PMID 25467202: "The scientific community thus recognizes endolymphatic hydrops as the anatomic substrate of Menière’s disease." --Saidmann (talk) 13:06, 29 June 2016 (UTC)

I think you've just supported what Jytdog has been saying all along. Similarly, non-bacterial thrombotic endocarditis (NBTE) is the anatomic substrate for infective endocarditis. It is therefore NOT the cause, but a necessary precondition. In the case of infective endocarditis, we know that the proximate cause is bacteremia (or fungemia); whether there is a contributor to MD beyond EH is unknown - as the cited MEDRS we've been discussing consistently say. — soupvector (talk) 02:30, 30 June 2016 (UTC)

The question is: Is there another (unknown) necessary contributor to MD? Only then can we say that EH is not sufficient for MD. Now, such other necessary contributors are neither known nor indicated by empirical evidence. None of what you and Jytdog referenced presented any such indication. To suggest there are such indications seems irresponsible to me. It would be tantamount to mystification. And mystification of the disease is a problem in MD - opening up big gates to various kinds of quackery. WP should not support such mystification. --Saidmann (talk) 12:23, 30 June 2016 (UTC)

Equalizing pressure in middle and inner ear

This subsection has now been reinstalled after addition of further secondary sources. It is now supported by four secondary sources and it is thus consistent with the rule "Primary sources may be presented together with secondary sources." in WP:MEDRS. --Saidmann (talk) 18:55, 9 July 2016 (UTC)

Hum

This ref "Alper, Cuneyt (2004). Advanced therapy in otitis media. Hamilton, Ont. Lewiston, NY: BC Decker. p. 395. ISBN 1-55009-201-4." does not mention the disease in question.

This ref is okay but is talking about the tentative evidence for tympanostomy tubes.[7]

Have adjusted Doc James (talk · contribs · email) 22:06, 17 July 2016 (UTC)

The ref "Alper, Cuneyt (2004). Advanced therapy in otitis media. Hamilton, Ont. Lewiston, NY: BC Decker. p. 395. ISBN 1-55009-201-4." was given as a source for the statement that the Valsalva maneuver is an established technique for additional ventilation of the middle ear. --Saidmann (talk) 10:57, 18 July 2016 (UTC)

So where does that ref say anything about ventilation of the middle ear being useful for Meniere's? In fact we have a better and newer source that says it is not. Doc James (talk · contribs · email) 16:39, 18 July 2016 (UTC)

There are two items belonging together, and each is based on valid secondary sources.

A. Additional ventilation of the middle ear helps in MD.

B. The Valsalva maneuver is an established technique for additional ventilation of the middle ear.

For A:

Walther LE (2005). "Procedures for restoring vestibular disorders". GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery. 4: Doc05. PMID 22073053.

and

Sterkers, O (2000). Meniere's disease 1999 - update. The Hague, Netherlands: Kugler Publications. p. 33. ISBN 978-90-6299-178-5.

For B:

Alper, Cuneyt (2004). Advanced therapy in otitis media. Hamilton, Ont. Lewiston, NY: BC Decker. p. 395. ISBN 1-55009-201-4.

--Saidmann (talk) 12:15, 19 July 2016 (UTC)

What you are doing is called WP:OR. We have one source that says tubes may help and we have a newer and better source that says they do not.

One does not get to draw the second conclusion as no source says valsalva helps. Doc James (talk · contribs · email) 15:59, 19 July 2016 (UTC)

I did not say this, either. The sentence was "An established non-invasive alternative for additional ventilation of the middle ear is the Valsalva maneuver,[22] also known as a common practice for ear clearing when diving or flying." There is no WP:OR in this sentence, not a word. It provides relevant information on the issue, and it is up to the readers how to use it.

Valsalva is non-invasive, costfree, and without adverse effects. It is a disservice to the readers and the patients to withhold this information. --Saidmann (talk) 11:02, 20 July 2016 (UTC)

The implication of its inclusion is that it's relevant to management of MD. So, the issue is whether the maneuver is relevant to MD - if MEDRS don't say so, then the inclusion is OR by implication. — soupvector (talk) 12:45, 20 July 2016 (UTC)

Or in other words it is off topic here. Doc James (talk · contribs · email) 00:53, 21 July 2016 (UTC)

Additional middle ear ventilation for MD patients is not off topic. The fact that such additional middle ear ventilation for MD patients is achieved by the non-invasive and costfree Valsalva technique is not off topic either. I will replace the source Alper by this source: PMID 22249864. It explicitly recommends valsalva for MD patients. Michael M. Paparella has been a leading authority in the field of MD since the 1980s. --Saidmann (talk) 11:35, 22 July 2016 (UTC)

That reference (available here - note that it's not available via Pubmed) is quite a disappointment - no evidence cited except personal anecdotes that explicitly include his wife (see last paragraph). Even more to the point, the relevant passage to the current discussion is this: "It is natural for the otologist in these patients to consider Eustachian tubal dysfunction as a primary etiological problem. A tympanogram is taken in these patients and if there is any question about Eustachian tubal dysfunction the patient should be treated with decongestants and anti-hystemetics systemically, a nasal spray and Valsalva maneuvers. Usually this suffices if the Eustachian tube is at fault." What that explicitly says is that if the patient's symptoms are linked to Eustachian tubal dysfunction as a primary etiological problem then Valsalva is one of the potential treatment modalities. — soupvector (talk) 18:29, 22 July 2016 (UTC)

Now you have cut out what "these patients" refers to. It refers to "classical or early (insipient) Ménière's disease" and "symptoms can be referable ... primarily to the cochlea" and "many patients who have complained of pressure and tinnitus" and "loudness intolerance (recruitment)". All this refers to patients who have the cochlear subtype of MD called "cochlear Ménière's disease" (see 3rd paragraph of Paparella's article). So we are dealing with MD patients here. Like in all MD patients also in those with the subtype "cochlear MD" Eustachian tubal dysfunction can be a primary etiological problem. For this subgroup of MD patients with Eustachian tubal dysfunction the treatment by additional middle ear ventilation is of particular benefit. Endline: Paparella says that valsalva is a recommended measure in MD. --Saidmann (talk) 20:27, 22 July 2016 (UTC)

The source is inadequate - an opinion piece without scientific evidence. — soupvector (talk) 21:07, 22 July 2016 (UTC)

Synonyms

Ref says "Previously used terms: Menière’s syndrome, endolymphatic hydrops (EH)"[8] Doc James (talk · contribs · email) 23:39, 25 July 2016 (UTC)

[9]--Ozzie10aaaa (talk) 23:49, 25 July 2016 (UTC)

Thanks User:Ozzie10aaaa. While not currently the correct term appears to be still used. Doc James (talk · contribs · email) 00:10, 26 July 2016 (UTC)

Supporting text

What text supports "Accordingly, the major stages in the mechanism are as follows:

unknown original causes ⇒

endolymph build-up (endolymphatic hydrops, EH) ⇒

temporary dysfunction and loss of the sensory cells ⇒

typical symptoms of MD: vertigo, hearing loss, and tinnitus."

Unable to find it in here [10] Doc James (talk · contribs · email) 19:32, 18 August 2016 (UTC)

In [7]: "In the organ of Corti of the hydropic animal, the first abnormalities are a loss of the shorter stereocilia (37) or a disarray and loss of stereocilia of the outer hair cells first occurring in the apical regions (38). The changes at the endolymphatic surface became more severe with time and outer hair cells are subsequently lost, followed by inner hair cells," This text explicitly "supports" the line "temporary dysfunction and loss of the sensory cells".

The total preceding text, including the refs, of the section Mechanism "supports" the summarizing lines, as is common when a short summary appears at the end of a section. And in such a case it is not common to repeat the refs of the preceding text in the summarizing lines. --Saidmann (talk) 11:06, 19 August 2016 (UTC)

I do not see how that supports the text in question so removing. Doc James (talk · contribs · email) 16:20, 19 August 2016 (UTC)

Yep it is WP:SYN Jytdog (talk) 18:22, 19 August 2016 (UTC)

A hydropic animal is an animal with EH. The review says that in these animals the occurrence of hair cell damage and then hair cell loss increases with time. This clearly "supports" lines 2 & 3 of the summary. Lines 1 and 4 of the summary "are supported" by the other refs of the mentioned preceding text. What is the problem? --Saidmann (talk) 17:32, 20 August 2016 (UTC)

You are still pushing the EH theory of causation and its mechanism way too hard. I just made these edits to restore the nuance. As source 7 says "The relationship between endolymphatic hydrops and Meniere's disease is not a simple, ideal correlation. " Please stop trying to represent it as though it were. Jytdog (talk) 18:30, 20 August 2016 (UTC)

Ménière's disease or Menière's disease

From http://blogs.bmj.com/bmj/2016/11/28/richard-lehmans-journal-review-28-november-2016/

"One in the ear for Menière’s

Prosper Menière first described a condition characterized by spells of vertigo and gradual loss of hearing. His son decided to spell his surname Ménière, and so does The Lancet. People in a hurry omit both accents. Let us respect this great man of learning and get his name right, whenever we can remember to."

Should we make this page a redirect to Menière's disease? Richard Keatinge (talk) 21:49, 3 December 2016 (UTC)

And we have Prosper Ménière Doc James (talk · contribs · email) 22:34, 3 December 2016 (UTC)

Notable cases

Per WP:MEDMOS we generally don't include people in lists at diseases like this unless the person had some significant effect on the history of the disease. Moved here per WP:PRESERVE

Notable cases

• Ryan Adams, an American musician, had to take a two-year break from music due to severe symptoms of the disease and his resulting psychological distress.
• Marc Almond, singer and songwriter; stated in his autobiography Tainted Life that "I have an inner-ear problem which has caused me difficulty throughout my career. My hearing in my right ear is slightly impaired due to a hereditary affliction called Menier's disease [sic], which also affects the balance. I learned a long time ago to sing with my headphones off that ear and on low volume, so I can actually hear myself live in the room."
• Muhammadu Buhari, Nigeria's President and former military head of state.
• Kristin Chenoweth, Broadway, film, TV actress, and singer.
• Brent Crosswell, former Australian Rules football player.
• Mamie Eisenhower, wife of Dwight D. Eisenhower, 34th President of the United States.
• Doc Hammer, painter and co-creator of The Venture Bros. He has stated repeatedly that he has Ménière's disease.
• Chris Packham, English naturalist and wildlife presenter for the BBC. He has Ménière's disease since the age of 37.
• Varlam Shalamov, a Russian writer, was affected.
• Alan B. Shepard, the first American astronaut and fifth man on the Moon, was diagnosed with Ménière's disease in 1964, grounding him after only one brief spaceflight. Several years later, an endolymphatic shunt surgery (which was then at the experimental stage) was performed, allowing Shepard to fly to the Moon on Apollo 14.
• Jonathan Swift, Anglo-Irish satirist, poet, and cleric, is known to have suffered from Ménière's disease.
• Dana White, president and minority owner of the Ultimate Fighting Championship (UFC). White had surgery on the condition but the procedure was a failure. After the failed surgery White had another procedure involving the use of stem cells; this time the procedure was successful.
• Tara Lipinski, American Olympic gold medalist figure skater.

References

-- Jytdog (talk) 03:57, 19 October 2017 (UTC)

Thanks User:Jytdog, good move. A comment on someone have condition X, Y, or Z is not notable enough to go on the condition page IMO (if people wish to put that detail on the page about the person sure). There should be significant coverage on them having the condition and what it has mention for the condition over multiple notable publications. Like Michael J. Fox and Parkinson's Doc James (talk · contribs · email) 11:02, 19 October 2017 (UTC)

The Wiki article on Adrienne Monnier, pre-WWII Paris bookseller, partner of Sylvia Beach and literary doyenne, says she was diagnosed with Ménière’s in 1954. She committed suicide a year later. Cieljaune (talk) 14:28, 2 April 2018 (UTC)

Diet 1

Dear Sir/Madame, I'd like to bring to your attention a problem regarding your MENIERE'S DISEASE page (in English). It contains a wrong info that can mislead people suffering from this syndrome and that can results in seriously damage their health. The sentence I'm referring to is the following: <<People with MD are often advised to reduce their salt intake, but the evidence for this is not very good.>>, published on the chapter DIET. Affirming that the evidence for reducing the salt intake "is not very good" equals to say that eating salt doesn't make much difference, while it's the MAIN therapy available, so far! The hydrope in the middle ear caused by a high sodium intake is the reason of dizziness, vomiting and drop falls in these patients and can results in a permanent earing loss! I tried to correct this article by erasing this single lines: <<but the evidence for this is not very good.>> but my editing has been rejected. I also sent an email to the author, begging him to help me with this problem, but he didn't answered. Please, try to understand that this a serious matter, it effects people's health! I'm married to a Meniere's Syndrome patient, I know what I'm talking about! This is a problem only appearing on the English page, since the Italian one is perfect! — Preceding unsigned comment added by WikiAur (talk • contribs) 10:17, 25 June 2018 (UTC)

The cited article to the sentence, "People with MD are often advised to reduce their salt intake, but the evidence for this is not very good" saysThe literature lacks controlled studies of this therapy based on modern Ménière’s disease definitions hence the sentence itself is border POV.--jojo@nthony (talk) 11:12, 25 June 2018 (UTC)

The person you emailed did answer. We have multiple high quality recent references that says that salt reduction has not been well studied.

Specifically "Patients are advised to eliminate the use of salt at the table and limit its use during cooking... These recommendations are based on expert opinions but evidences are lacking."[11] Doc James (talk · contribs · email) 11:27, 25 June 2018 (UTC)

I would suggest the sentence is rephrased to mean salt reduction has not been well studied. That may help eliminate the confusion.--jojo@nthony (talk) 11:55, 25 June 2018 (UTC)

Sure and done. Doc James (talk · contribs · email) 16:17, 25 June 2018 (UTC)

Intratympanic/Transtympanic Gentamicin Treatment for Meniere's Disease

It is my suggestion that this treatment protocol is also reviewed by the editors to consider whether the details could be included in the article. [12] [13] [14] [15] [16] I am an MD patient and I underwent this treatment in 2015. I have not had an attack since then though symptomatic discomforts within manageable levels persist. --jojo@nthony (talk) 13:20, 25 June 2018 (UTC)

We mention it here "In cases where there is significant hearing loss and continuing severe episodes of vertigo, a chemical labyrinthectomy, in which a drug (such as gentamicin) that "kills" parts or most of the vestibular apparatus is injected into the middle ear" Doc James (talk · contribs · email) 16:24, 25 June 2018 (UTC)

Diet 2

Dear Sir/Madame, the use of Wikipedia's writing tools is not as intuitive as I hoped, therefore my contribution can not be very significant. I only hope that someone of your moderators will understand how important is to correctly edit the sentences that I pointed at. OK, the author answered my email, I've just seen his email on my mailing box, I thought that the answear would appear here on Wikipedia like your other communications, that's why I thought that he didn't answer. I apologize for the misunderstanding. Please, try to understand that the corrections that you suggest don't clear at all the confusion about the right diet in patients suffering from Meniere's Disease. As I said, this problem only effects your English page, the Italian one is just perfect. Anyway, since I finally got a direct contact to the author, I will discuss this matter in private with him. Thanks for for your attention, and sorry for the inconvenience: I'm dealing with a language that is not my mother language, and with a very complicated tool (Wikipedia). Have a nice day. — Preceding unsigned comment added by WikiAur (talk • contribs) 13:35, 25 June 2018 (UTC)

PS: Here it is some studies that proved the importance of salt reduction in Meniere's patients: < t is suggested that high sodium levels may induce endolymphatic hydrops. The observation that water retention can exacerbate the symptoms of Ménière's disease was first documented in 1929 (Dederding 1929). (...) More recent studies of restricted salt intake, usually together with other treatment modalities, such as the use of diuretics, have also suggested better symptom control in patients with Ménière's disease (Klockhoff 1974; Santos 1993). As such, dietary salt restriction is recommended by many clinicians." http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD012173/full

At least you moderators can now have an idea of what I was trying to say. Thanks again. — Preceding unsigned comment added by WikiAur (talk • contribs) 16:41, 25 June 2018 (UTC)

That is a protocol for a proposed systematic review. It is not a systematic review itself. Doc James (talk · contribs · email) 17:22, 25 June 2018 (UTC)

Dear Sir/Madame, the section DIET on the english pahe of MENIERE'S DISEASE is poor and misleading. By quoting this sentence: "Reducing salt intake, however, has not been well studied" you seriously risk to damage the health of people suffering by this condition, inducing them in thinking that, since "the salt intake has not been well studied", the doctors' indication to follow a low sodium diet is just a generic advice, not something scientifically proved. There are other sources, that I quoted, affirming the opposite: there are studies proving the benefits of a low sodium diet. The author of the page, that I kindly contacted twice in private, seems not to understand this point. He also seems to ignore the difference between salt and sodium. In a previous edition of his, he wrote that it is suggested to both avoid salt in table salt and in cooked products, showing ignorance about the fact sodium is also an element of many raw products, such as cured meats and cheese. I kindly ask you to edit the DIET chapter by erasing the sentence "Reducing salt intake, however, has not been well studied" and e quoted references since what it's claimed in this sentence and its source it's not only unnecessary and potentially harmful, it also conflicts with the sources that I previously quoted on this topic. Thanks. — Preceding unsigned comment added by WikiAur (talk • contribs) 22:42, 25 June 2018 (UTC)

Wikipedia content about health summarizes references. The references need to be a) recent literature reviews in good quality journals or b) statements by major medical or scientific bodies. The guideline that describes these criteria is called WP:MEDRS. It is has broad and deep consensus in the editing community.

Please reply here and cite the sources that fit those criteria and that support the idea you would to add to this article. None of the sources you have cited so far meet the criteria. Jytdog (talk) 00:26, 26 June 2018 (UTC)

Dear Sir/Madame, I'm aware of the Wikipedia's policy about sources and quoting references. Unfortunately I'm not capable to properly use the Editing tools of your Encyclopedia, it's too comp!icated for my skills. I dare to disagree, though, that the studies that I mentioned, one from the '70s and the other from 1993, are not "recent" or authoritative enough. As for the difference between "salt" and "sodium", a simple dictionary would clear the confusion. Please, try to understand that the line that I contest is absolutely unnecessary to the purpose of giving people a correct information about this disease, and as I already said it might seriously mislead more than one patient suffering from this condition. A member of my family has been under a strict low sodium diet for the last three years, having as a result a dramatic improvement of his symptoms; and yet, a few days ago, after having read your page in English about MENIERE'S DISEASE, he was about to quit the diet persuaded that, given the lack of evidences, the diet was not important. This is a personal matter, and I wouldn't discuss it in public, but the private messaging with the author of the Wiki page didn't lead to anywhere, so I reckon you moderators should know that there is at least one person in the world who was about to be damaged by your superficiality in quoting a source that is not telling the whole truth about this disease. Keep in mind that Wikipedia got several pages in different languages about Meniere's Disease, and they are not consistent, they don't all display the same infos. The Italian one - which I can perfectly read since Italian is my mother language - doesn't show the line that I contest. So, what difference would make to you deleting that line on the English version? If you can spare some disconfort and sufference to English speaking Meniere's patients, why not to do so? You have a big responsibility here, please, try to understand! — Preceding unsigned comment added by WikiAur (talk • contribs) 03:11, 26 June 2018 (UTC)

Please stop creating new sections. Please read WP:THREAD.

Everything here is based on sources. No one will take action on what you are asking if you do not bring good sources, as described above, to support it. Jytdog (talk) 05:39, 26 June 2018 (UTC)

The relevant paragraph in the Italian page --khttps://it.wikipedia.org/wiki/Sindrome_di_Meni%C3%A8re#Trattamento -- is garbage. It has no sources. We will not make this page into garbage. Jytdog (talk) 05:43, 26 June 2018 (UTC)

Well, you called "garbage" one of your own pages, that's funny! I will remember that while talking about Wikipedia with my friends: "Hey guys, don't take Wikipedia's infos too seriously, they reckon that they publish garbage!", ahahah! I already gave you the right sources, and I apologetically explained that I'm not able to follow the instructions that you provide on the site: is it against the law to be internet-clumsy? I hope no! I will stop talking, as you ask, but you should know that you are not good people, IMHO: your stubborn attachment to a useless line of a single source might damage the health of some of your readers, and yet you don't want to take action in that. Thanks for nothing. Kind regards — Preceding unsigned comment added by WikiAur (talk • contribs) 08:49, 26 June 2018 (UTC)

Well we are accurate here at least. Doc James (talk · contribs · email) 18:08, 26 June 2018 (UTC)

Whiplash

User:Michael Burcon would you please acknowledge that you have seen the welcome message at your talk page, User_talk:Michael_Burcon#Welcome, and have read it? Thanks. Jytdog (talk) 17:14, 6 September 2018 (UTC)

Vertigo and tinnitus

Neither are commonly understood terms. Per WP:MEDMOS we should define what they mean at least in the lead as we are too be writing for a general audience. By the way an analysis of the leads of our medical articles finds that they are writing at just over a grade 12 level on average (down from over a grade 15 level 6 years ago). This improvement has occurred as a result of a consistent effort by a small group of us. Doc James (talk · contribs · email) 16:13, 13 January 2019 (UTC)

Both are commonly understood terms. In a large corpus of English, they both occur with similar frequency to related words such as "dizziness", "migraine", "rash", "ache", "flu". You have not offered any evidence that they are not commonly understood, and if you want your claims about "grade level" to have any weight you'll need to link to whatever analysis you've done, explain how you defined your terms, and state what that has to do with this article and the infantile wording you want to include. 37.152.231.125 (talk) 10:57, 15 January 2019 (UTC)

what references back up your initial statements 37.152.231.125 ?--Ozzie10aaaa (talk) 13:18, 15 January 2019 (UTC)

Requesting edit about Meniere's Disease being fatal

The vestibular system is essential to normal autonomic breathing as was confirmed by Dr Reuben's study on ear dysfunction and SIDs. I see no mention of Meniere's being fatal so is it OK if I can edit this? The idea of inner ear dysfunction causing asphyxia is not new, studies go back to 2011 and was proven using studies on mice. — Preceding unsigned comment added by 2.29.86.79 (talk) 01:04, 26 April 2019 (UTC)